1861556920 NPI number — CHEMAWA INDIAN HEALTH CENTER DHHS IHS WESTERN OREGON SERV UNIT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861556920 NPI number — CHEMAWA INDIAN HEALTH CENTER DHHS IHS WESTERN OREGON SERV UNIT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHEMAWA INDIAN HEALTH CENTER DHHS IHS WESTERN OREGON SERV UNIT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861556920
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3750 CHEMAWA RD NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97305-1119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-304-7600
Provider Business Mailing Address Fax Number:
503-304-7678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3750 CHEMAWA RD NE
Provider Second Line Business Practice Location Address:
CHEMAWA INDIAN HEALTH CENTER WESTERN OREGON SERVICE UNI
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97305-1119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-304-7600
Provider Business Practice Location Address Fax Number:
503-304-7678
Provider Enumeration Date:
12/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BIRDINGROUND
Authorized Official First Name:
ADAM
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
503-304-7642

Provider Taxonomy Codes

  • Taxonomy code: 332800000X , with the licence number:  AP8985218 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 270030 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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